ST.

MARYS COLLEGE
NURSING PROGRAM
Tagum City

A CASE STUDY
On

ACUTE RENAL FAILURE

Presented to:
Elizabeth Ladroma, RN

In Partial Fulfillment of the Requirements

In
Related Learning Experience
(RLE)

By
Mia Charisse F. Lamparero
Morris Antiporta
Janice Idiong
Stephen Anthony Navarro
Catherine Ardina
Neko Nebres
BSN 4

January 11, 2011

TABLE OF CONTENTS

I. INTRODUCTION
A Objectives
II. ASSESSMENT
A. Biographical Data
B. Chief Complaint
C. History of Present Illness
D. Past Medical and Nursing History
E. Personal, Family and Socio-Economic History
F. Developmental History
G. Patient Need Assessment
Physical Assessment

General survey

Vital signs

Nutritional status

Integumentary System

HEENT

Pulmonary System

Cardiovascular System

Gastrointestinal System

Musculoskeletal System

Genito-urinary System

Course in the Ward

III. LABORATORY AND DIAGNOSTIC EXAMINATIONS

IV. PATHOPHYSIOLOGY
A. Discharge Plan
V. PHARMACOLOGICAL MANAGEMENT
VI. BIBLIOGRAPHY
A. Textbooks
B. Internet Download

I. INTRODUCTION

As nurses, we could help our patients by having a deep understanding of the

disease, that we may learn the proper interventions for the acute kidney disease patients.
In this way, we could render quality care for them. We could as well lead them to the
proper treatment to lessen their sufferings brought by the kidney failure, in anyhow. By
having a wide understanding of the disease, we could impart teachings on how we could
prevent the worsening of the condition. As nurses, it is our responsibility to render
information and impart health teachings to improve the condition of our patients to the
best of our abilities. One of the characteristics that we, nurses, should have is to be
informative and only through a keen study of disease such as this way for us to gain all
the information that we need to learn.
OBJECTIVES
The research for this case study, its data and substantial facts could not be attained
without the improvised objectives that are needed to be followed and observed that will
guide us in planning, preparing and arranging the information systematically. The
objectives are devised within the day of our clinical exposure. The objectives would serve
us guiding principles for us to arrive to our goals and aims.
A. General Objective:
Within the time-span of duty, the student nurse will complete the chosen case to
be studied with factual pertinent data gathered. As well as to know and familiarize other

related information connected to it and apply the nursing skills that had learned and
practice not only or the call of this study but also for the future reference.
B. Specific Objectives:

To obtain sufficient and relevant information regarding patients condition.

To present personal data of the patient.

To trace the present history of the patients health and illness and define the
diagnosis of the patient having Acute renal failure.

To conduct a thorough head-to-toe assessment serving as baseline data.

To present the pathophysiology of the patients diagnosis.

To identify the different drugs ordered and to know their action, indication,
adverse effects and nursing responsibilities.

To impart suitable and realistic health teachings to the watcher for the patients
welfare.

To evaluate the outcome of the condition of the patient.

II. ASSESSMENT

A. BIOGRAPHICAL DATA

Name

: Mrs. Banana

Age
Sex
Civil Status
Birthdate
Birthplace
Address:

:
:
:
:
:

Nationality
Religion
Occupation
Attending Physician
Admitting Diagnosis
Final Diagnosis

46 years old
Female
Married
November 13, 1964
Bohol
: Prk 19, Pag-asa, Mesaoy, New Corella, Davao

del Norte
: Filipino
: Roman Catholic
: Banana Plantation Worker
: Dr. Cyrus Asis MD
: Polyneuropathy; T/C UTI
: Acute Renal Failure 2 Severe Dehydration 2 AGE

B. CHIEF COMPLAINT
The patient was admitted at Bishop Joseph Reagan Memorial Hospital last
December 12, 2010 at 8:53 in the morning due to the complaint of generalized body
malaise She was attended at the Emergency department and had taken a clinical history
and physical assessment. She was immediately transferred at St. Joseph Right Wing room
319-6. He was attended by Dr. Asis, a resident physician of the said hospital.

C. HISTORY OF PRESENT ILLNESS

Three days prior to admission, patient had loose bowel movement of about five
times associated with vomiting more than ten times and abdominal pain, fever, dysphasia
and body malaise. Four hours prior to admission had severe generalize body malaise with
five episodes of loose watery stool, non- mucoid, non blood streaked. No consultation
done, no medications taken two days prior.
D. PAST MEDICAL AND NURSING HISTORY
Mrs. Banana was known for being hypertensive for 5 years now. She was
hospitalized in Davao Regional Hospital because of the said health problem. According
to her, her chief complain that time was only hypertension. She was discharged from the
hospital after six days of confinement.
On December 12, 2010 she was then experiencing loose bowel movement and
body malaise that cannot be tolerated anymore which led them to admission.

E. PERSONAL, FAMILY AND SOCIO-ECONOMIC HISTORY

Aka Mrs. Banana is a 46 year old banana plantation worker. She was
separated from her husband who led her to work in order to sustain their needs. The
family of Mrs. Banana belongs to a marginalized socio-economic status. In order to
provide and sustain the daily needs of their family, she works as a banana plantation
worker. She have 2 daughters: one is 9 year old and the other is 11 year old. She doesnt
have a history for hypertension and DM
F. DEVELOPMENTAL TASK

Robert J. Havighurst Developmental Task Theory

According to Havighurst developmental theory, Mrs. Banana, 46 years of age,

belongs to a period of late adulthood which was achieving mainly located in family,
work, and social life. Family-related developmental tasks are described as finding a mate,
learning to live with a marriage partner, having and rearing children, and managing the
family home. Mrs Drain was working at heavy workload just to have money to help for
their everyday expenses. She doesnt have time to care for her own needs because she
always attended her children first.
G. PATIENT NEED ASSESSMENT
Date: December 13, 2010
Name of Patient: Mrs. Banana Age: 46 years old

Sex:Female

Status: Married

Admission Date/Time: December 12, 2010 8:53 am

Admitting Medical Diagnosis: Polyneuropathy; T/C UTI
Arrived on Unit by: per stretcher

From: Emergency Room

Accompanied by: accompanied by her sister

AdmittingWeight /VS: 48kgs BP- 80/50 RR-26 PR-123 Temp- 36.7
Clients Perception of reason for Admission: Luya man gud kayo akong lawas maam
murag dili nako malihok as verbalized
How has problem been managed by client at home: NONE
Allergies: No allergies was being experience according to the patient
Medication (at home): NONE, (at the hospital): See Drug Study
Physiological Needs:
I. Oxygenation
BP : 50/60 PR 96 bpm RR 25 cycles/min CR_________

 Lungs (per auscultation: character: lung sound; symmetry of chest expansion;

breathing character and pattern.) fine, short, interrupted crackling sound was
being heard upon auscultation, symmetry chest expansion was being observe
during breathing.

Cardiac status (per auscultation

sounds character; chest pain?

Dull, low pitched and longer followed by a silent then higher pitch: no chest pain
noted
Capillary Refill: Within 2 3 seconds using the blanched test
Skin Character and Color: dry, pale, dark brown in color
Life-supporting Apparatus: O2 @ 2 LPM
Other Observations (related): Patient cannot be able to stand alone and
experiencing dizziness
II. Temperature Maintenance:
Temperature: 36.7 C
Skin Character: dry, pale, dark brown in color; with good skin turgor
Other Observations (related): N-O-N-E
III. Nutritional Fluid:
Height: 5 4/ 48kg.

Amount of food consumed: of meal served

consumed
Prescribed Diet:
Eating Pattern: 3x a day; can only consume of served meal

 Skin Character: dry, rough skin; with good skin turgor

Intake (IVF: Fluid/Water):
Other Observations (related):slightly obese and vomits all food eaten
IV. Elimination:
Last Bowel Movement (frequency; amount, character): 5-7 times, yellow to
amber in color, watery and plenty.
Normal Pattern: 2x a day
Urination (frequency, amount, character, sensation): twice, with yellow ambered
colored urine, about 200 cc.
Other Observations (related): experiencing watery stool and defecated 7x during
the shift.
V. Rest-Sleep:
Bed Time: 6: 00PM Waking Up Time: 6:00 AM
Sleep (amount of sleep): 4-5 hours
Problems (as verbalized): Wala ko katulog kagabii og luya kayo akoang
paminaw
Other Observations (related): N-O-N-E
VIII. Stimulation-Activity:
Work: Banana Plantation Worker
Reaction/Past time: Watching TV
Hobbies/Vices: None
Safety-Security Need

 Neuro V/S: 15/15

Mental Status (coherent, responsive, conscious, unconscious): Coherent,
Responsive and consciuos
Emotional Problem (diaphoretic, trembling, restless) Irritable, diaphoretic and
fatigue.
Love-Belonging Need
Children (living with?) Living with 2 daughters and raise them alone.
Husband (living with?) NONE

Self Esteem Need

-Need to accept to be independent but still needs assistance to people around him.
Appreciate the care and love of family. Need to discuss feelings and concerns. Interact
effectively to people.
Self- Actualization Need
- Control ones emotions and discipline self particularly in taking care of health. Need to
learn to listen and follow what is advised for easy recovery.

PHYSICAL ASSESSMENT

General Survey

Patient received lying on bed, awake, responsive, coherent to verbal communication,

dry lips, with normal capillary refill (less than 3 sec) ; fatigue and weakness noted and
verbalized on lower extremeties and unable to stand alone.

Vital Signs
Date/Shift Time
12/12/10
9am
11am
12nn
4pm
7:15pm
8pm
12/13/10
12mn
4am
8am
12nn
4pm
8pm
9:25pm
12/14/10
12mn
2am
3:30am
4am
5am
6am
8am
10am
12nn

Temp
36.2
36
37
38
39.8
38
36.8
36.8
36.8
37
36.8
36.4
37
36.7
36.3

BP
80/50
80/60
90/60
100/70
110/80
120/80
100/60
90/60
100/60
80/60
110/80
70/50
80/60
80/60
80/60
80/60
80/60
90/60
80/60
90/60
90/60
90/60

PR
123
103
98
96
85
90
86
88
90
94
89
60

RR
26
21
22
21
24
30
24
22
38
43
31
30

93

24

109

26

86

28

110

41

O2 SAT

OUTPUT OUTPUT

95%

92%

96%

93%

Nutritional Status

Upon admission, patient was on DAT. Normally takes meal 3 times a day but vomited
after. Depending on varied conditions, he consumes moderate amount of food per meal.
No known hypersensitivity to food allergens and other problems related to food
consumption.

Integumentary System

Fine and thin yet dry hair was noted. His nails were in convex shape, smooth in
texture, capillary refill of less than 3 seconds with pale nail beds. With good skin turgor,
dry, and brown in color.

HEENT

The size of head was in proportion with the body. The eyes were symmetrical with
the ears (pinna); pupils react spontaneously to light, with pale conjunctiva. Eyebrows
symmetrically aligned, eyelashes equally distributed, lids closed symmetrically. With
approximately 15 to 20 blinks per minute. No discharges noted on ears. Nasal septum
was intact and in the midline, no discharges or flaring, air moves freely through the nares.
Non-pitting edema noted at both feet.

Pulmonary System

With symmetrical chest expansion; crackles sound heard upon auscultation; RR: 30
cpm

Cardiovascular System

Cardiac sound from dull, low pitched (lub) to higher pitch (dub) sound , with
irregular cardiac rhythm ; 60 beats per minute abnormal. Capillary refill time takes less
than 3 seconds .

Gastrointestinal System

Watery stool plenty , non-mucoid and non-blood streaked.

Musculoskeletal System

Weakness and fatigue noted as manifestation of the disease process, marked reluctant
to move. With limited range of motion.

Genito-urinary System
Patient voided after meal in our shift. Urine appears amber in color, moderate in

amount. Clients normal voiding pattern is 4 times a day. Palpation on kidneys reveals no
evidence of tenderness and distention.
H. COURSE IN THE WARD

III. LABORATORY AND DIAGNOSTIC EXAMINATIONS

VII. PATHOPHYSIOLOGY

TYPES

ETIOLOGY

PRE-RENAL
-volume depletion
(Structurally intact hypotension
nephrons)
(systemic
hypovolemia)

WHAT HAPPENS

Reduced
or
deprived perfusion
of
kidney-renal
ischemiafunctional disorder
or depression of
GFR or both
RENAL
(with -acute
tubular The
necrotic
structural
and necrosis due to debris,
cellular
functional damage) ischemia
blebs block the
nephrotoxin
filteration barrier
-disease
of + macula densa is
slomeruli
also activated due
to chloride load
hence
causes
prerenal
vasodilation

CLINICAL
FINDINGS
There is decrease
in GFR so causes
oliguria, azotemia,
possible
fluid
retention
and
edema
Blocking
of
filteration barrier
also causes oliguria
and if oliguria
nitrogenous
compounds
and
creatinine
is
obviously increased
in blood.

POST-RENAL
(Obstruction
of
urine
flow
in
anywhere
along
urinary tract

-obstruction
lumen
-compression
lumen

of Urine outflow is
obstructed
so
of further filtration is
declined.

There is decrease
in GFR so causes
oliguria, azotemia,
possible
fluid
retention
and
edema.

B. Discharge Plan
To the patient who is diagnose of having acute renal failure, it is deemed necessary
that after the hospital stay, compliance of the following action must be strictly observed
for rehabilitation.

Medications -

Advise the client to take the medications on time to preserve the

efficacy of the drug. Instruct the client to take the medication with food to avoid GI
irritation.
Exercise/Economic Factor -

Encourage to do a routine ambulation as a light

exercise. Advise not to engage in strenuous activities. Encourage to take rest every after
activity.
Treatment

Encourage to ask proper explanation before starting a procedure to

properly understand what is going to happen. Instruct client to ask and properly
understand before signing the consent.
Health Teaching

- Encourage patient to take a bath and do ADLs within limits if her

safety. Tell the patient to notify the physician immediately if there are unusualities.

Follow all instructions including medications, diet regimen and dos and donts that was
instructed to her by the physician..
Out patient Follow-up

- Advise to have a follow up check up any time after

discharge.
Diet - Instruct patient to eat nutritious, high protein diet to promote healing and eat
smaller, more frequent meals to decrease feeling of fullness and bloating.
Spiritual/Sexual Activities - Encourage to reflect on her life situations and properly
understand these situations. To pray every day to help in coping up ones spirituality.
IX. PHARMACOLOGICAL MANAGEMENT

XII. BIBLIOGRAPHY

A. Textbooks
Douges, M.E. et.al., (2002). Nurses pocket guide: diagnosis, interventions &
rationales. (8th Edition). Philadelphia: F.A. Davis Company.
Douges, M.E. et.al., (2002). Nursing care plan: guidelines for individualizing
patient care (6th Edition) Philadelphia: F.A. Davis Company.
Gulandick, M. et.al., Nursing care plan. (3rd Edition)
Ignatavicius, D.D. & Workman, M.L. (2006). Medical-surgical nursing: critical
thinking for collaborative care. (5th Edition). St. Louis, Missouri: Elsevier Saunders.
Kozier, B. et.al., (2004). Fundamentals of nursing: concepts, process & practice.
(7th Edition). Philippines: Pearson Education South Asia PTE Ltd.

Smeltzer, S.C. & Bare, B.G. (2004).Textbook of medical-surgical nursing(10th

Edition, Volume 2). Philadelphia: Lippincott Williams and Wilkins. pp 553-538.
Spratto, G.R. & Woods, A.L. (1994). Nurses drug reference. USA: Delmar
Publishers Incorporated.
Ulrich & Canale. (2005). Nursing care planning guides. (6th Edition).
B. Internet Downloads
http://www.labtestsonline.org/understanding/analytes/hematocrit/test.html
http://en.wikipedia.org/wiki/Leukocytosis
http://www.healthline.com/adamcontent/fatigue#hl2
http://www.emedicinehealth.com/chest_pain/page3_em.htm

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